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Caffeine is good for preterm babies…
Caffeine for Apnoea of Prematurity. The CAP trial was conceived out of concern about the possible adverse long term effects of caffeine on neurodevelopment, because it was a drug that was widely prescribed even though nothing was known about any long term harms. It turned out that caffeine was actually better than placebo at 2 years but its advantage seemed to have been lost by 5 years. In 2017 the trial reported that there were lower rates of motor impairment among 11 year olds in the intervention arm (JAMA Pediatr. 2017;171:564–572). Now we learn that at 11, actively treated participants had better visuomotor, visuospatial and visuoperceptual abilities without any difference in intelligence or behaviour (Pediatrics. 2018;141:e20174047). Treatment with caffeine seems to confer positive advantages on preterm babies, and the CAP trial just goes on giving.
…but all AEDs can be harmful to fetuses
The EURAP register of pregnant women treated with anti-epileptic drugs has yielded high quality data on the relative risks of different AEDs at different doses for major congenital malformation (Lancet DOI: 10.1016/S1474-4422(18)30107-8). Analysed by drug, sodium valproate carried the highest rate, …
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